5. How is breast reconstruction performed?
Step One – Anesthesia
You will be administered one of the following for your breast reconstruction surgery:
- Intravenous sedation
- General Anesthesia
Step Two – Flap Technique – Repositions a woman’s own tissue to create or cover the breast mound
If you are left with insufficient tissue on the chest wall to cover and support a breast implant due to a mastectomy or radiation therapy, the breast reconstruction usually requires a flap technique or tissue expansion.
A “TRAM” flap technique uses a donor muscle, fat, and skin from your lower abdomen to reconstruct the breast. The flap may remain attached to the original blood supply and be tunneled up through the chest wall or completely be detached and formed into a breast mound.
As an alternative to the “TRAM” flap technique, your surgeon may choose the “DIEP” or “SIEA” flap techniques. These methods do not use your lower abdomen muscle but transfer only the skin and fat from the abdomen to the chest. Other donor locations, such as the buttocks or thighs, can be used if there isn’t enough tissue on the lower abdomen to transfer.
Step Three – Tissue Expansion – Gradually stretches healthy skin to provide coverage for a breast implant
An implant-based reconstruction is a viable option for women who did not require breast radiation and want to avoid surgery on a donor site. Reconstruction with tissue expansion is an easier recovery when compared with flap reconstruction, but it can be a lengthier process.
Following the insertion of the expander, you will have multiple office visits over the next 1-2 months to progressively fill the device with saline through an internal valve. If the expander is not designed to be a permanent implant, a second procedure will be required to replace it after it has been filled.
Step Four – Placement of a breast implant create a breast mound
Breast implants can be used in conjunction with or instead of flap surgery. During breast cancer treatments, an implant can also be used as a temporary placeholder until you’re ready for more complex flap reconstruction techniques.
Your surgeon will help you determine the most suitable technique and procedure for you. Tissue expansion is frequently required for implant-only reconstruction. However, direct-to-implant breast reconstruction may be an option for some women undergoing mastectomy with certain tumor characteristics and breast shapes.
Step Five – Reconstruction of nipples and areolas
Breast reconstruction is done using several procedures that restore the nipple and areola for women who are not candidates for nipple-sparing mastectomy. The most common techniques involve folding skin into the shape of a nipple and then tattooing it. In addition, three-dimensional nipple-areola tattooing may be used alone to create the appearance of a realistic nipple with the illusion of projection.